ES2345974T3 - CARRIAGE ASSEMBLY TO CONTROL A STEERING CABLE STEERING MECHANISM WITHIN A FLEXIBLE AXLE. - Google Patents

Abstract

An electromechanical assembly, comprising: a) at least one selectively engageable steering motor (130) for engaging a steering wire (140), b) at least one spring means (220) for biasing said steering wire toward a taut state, and c) at least one selectively engageable carriage motor (240) for overcoming the bias created by said spring means.

Description

Carriage assembly to control a mechanism Direction of steering cables within a flexible shaft.

Background of the invention Field of the Invention

The present invention generally relates to electromechanical devices for use with instruments surgical, and more particularly to a carriage assembly electromechanical that is combined with a steering mechanism of steering cables located inside a flexible and controlling shaft said mechanism, suitable for use with a drive assembly electromechanical, by which they can be operated remotely surgical accessories comprising anastomosis instruments, Staple suture and resection.

Description of the prior art

When the presence of tissue is detected cancerous or other abnormal tissue in the tract gastrointestinal, an intervention is often prescribed surgical The field of cancer surgery and, more particularly, the surgical intervention by means of which remove a section of the gastrointestinal tract that comprises cancerous or abnormal tissue, comprising a series of instruments exclusive design. In combination with a description of the present instrumental and its functions, a description is also provided of the state of the art in this surgical intervention.

The first question to answer for determine how a gastrointestinal cancer should be treated refers to the specific situation of the cancerous tissue. This issue is very important insofar as the instruments available in the present state of the art suffer from certain limitations related to the distance to which they can be inserted within the gastrointestinal tract. If the cancerous tissue of the colon is in a very remote position, for example, then the conventional instruments available are useless and, therefore, it needs a special adaptation. For the In general, these adaptations increase the risk of contamination of the surrounding tissues with the contents of the intestine, increase the duration of the intervention with the consequent need to apply anesthesia and eliminate the benefits of anastomosis and suture by precision staples achieved by use of a mechanized device.

More particularly, in case the tissue cancerous be located in a position of the colon that is accessible by means of the present instrumental, the abdomen is initially opened of the patient to expose the intestine. TO then the surgeon uses a cutting and suturing device by linear staples with which the colon tube is cut by both sides of the cancerous tissue, thereby creating two extremes intestine staples (a distal end that is directed toward the anus and a proximal end that is closer to the intestine thin). This is done in order to temporarily reduce To a minimum pollution.

More particularly, with reference to the figure 1, the intestine is placed between the scissor elements 12, 14, in the tip of the linear staple suture instrument 10. When tightening the trigger 16 located on the handle 18 of the device, the surgeon makes the scissor elements 12, 14 come together. Then, a second shot (or secondary action of the same trigger) to apply a series of staples 20 through the compressed end of the colon, whereby the ends close and transect.

Then the surgeon partially opens the proximal end and inserts the detachable anvil part of a anastomosis and staple suture instrument at the end proximal that is open. This stage, as well as the rest of the surgical intervention, is related to the functioning of This surgical instrument. More particularly, and with respect to Figure 2, the surgeon begins by holding the instrument 30 and by manually rotating the disc 32 located at the base of the handle 34, to make the anvil head 36 located at the end otherwise move forward. The surgeon continues to turn the disk 32 until the head of the anvil 36 advances until it reaches its extended position more extreme. This manual turn requires almost thirty complete rotations. Once the advance is complete, the tip the anvil of the instrument is decoupled from it and inserted in the partial opening of the proximal end, such that the coupling rod extends through this towards the Exterior. Next, this partial opening of the end Proximal is closed by a suture. Then the shaft Extensible 38 of the staple anastomosis and suture instrument 30 it is inserted and advanced through the lower colon, transanally, until the coupling rod 40 of this is introduced to through the stapled distal end. The surgeon then joins the coupling ends of the anvil and shaft and starts again at turn the handle disc manually, this time to bring the Anvil head to shaft end 42.

When the anvil head and shaft are together, after manually turning the disc another thirty times, the surgeon manually activates a lever-type trigger 44 located in the handle. This action causes a circular blade 46 to advance axially out from the shaft tip, and come into contact with the opposite face 48 of the anvil 36. The blade cuts the closed ends with staples of the proximal and distal ends of the colon, also cutting a new pair of ends of the parts proximal and distal colon. The tissue that has been sectioned is keeps in an internal volume at the end of the axis.

Synchronized with the cut, the ends newly opened are joined by a series of 50 staples that pass through holes located on the perimeter of the tip of the shaft (which is pushed and closed against the opposite face of the anvil). Finally, the coupled shaft and anvil are removed from the patient.

More particularly, with respect to the structural characteristics of the suture instrument by linear staples 10 of the prior art illustrated in Figure 1, the device comprises a pistol grip structure 18 having an elongated shaft 19 and a distal portion 20. The distal part comprises a pair of scissor-like pressure elements 12, 14 that compress the open ends to close the colon. Actually, only one of the two scissors type elements, the upper jaw part 12, moves (pivots) in relation to the overall structure; The other remains fixed. The operation of these scissor means (the pivoting of the upper jaw part 12) is controlled by a lever-type trigger with eyelet 16 that is held in the handle. Within the scope of the prior art, a set of different means for keeping the tips of the scissor blades closed, including snap fasteners, tweezers, clamping rings, et al.

In addition to the scissor means, the distal part It also comprises a staple suture mechanism. Gag motionless bottom 14 of the scissor mechanism comprises an area of reception of the staple cartridge 20 and a mechanism for pushing the staples 20 up through the compressed end of the colon, against the upper jaw part, thereby sealing the open end previously. Scissor elements can form part of the shaft or can be removable, then being possible exchange various scissors and suture elements for staples

More particularly, with respect to structural characteristics of the anastomosis instrument and Suture by prior art staples illustrated in Figure 2, the device comprises an anvil part 36, a staple part, blade and reservoir 42, a shaft part 38 and a handle part 34. The anvil part 36, which can be selectively disassembled from the shaft tip, bullet-shaped and has a top flat, a flat support surface for cutting 48 in the part bottom and a coupling rod 41 projecting axially by the lower surface.

The staple, blade and deposit part 42 (SBR part) of the instrument is located at the distal end of the instrument and comprises a coupling rod 40 that can move forward and backward selectively to receive selective the anvil part. This stem action of coupling is possible thanks to a threaded shaft mechanism and worm mounted on handle 34 (described in greater depth later). The SBR part has a cylindrical shape and forms a hollow shell. This internal cavity forms the deposit 47. The blade 46 is equally cylindrical and is arranged in the internal part of the housing, against the internal wall of the same. The blade can move axially out of the housing of selectively, in accordance with the operation of a trigger mechanism 44 of the handle (also described in greater depth later). On the axially oriented surface towards the outside of the cylindrical wall of the housing, it is a series of openings that allow the output of the clips 50 of the device. The same drive that makes the blade move forward also determines the progress of a series of staple drives inside the cylindrical walls. Plus exactly, the staple driver is a cylindrical component that It presents a series of protrusions at its axial end, being located the bumps in accordance with the distribution of the staples and the holes. Before being applied, the staples are install in the holes and pass through the holes through the action of the staple impeller and the protuberances of East.

The part of axis 38 of the instrument is a rigid and simple extended structure whose purpose is to provide a wrap for a pair of elongated rods. The first rod is coupled to the worm mechanism mentioned above and described in greater depth below with respect to the part of the handle, and constitutes the means that allows to advance and selectively retract the anvil part and the stem of coupling of the SBR part. The second rod is coupled to the handle trigger 44 at one end (also mentioned above and described in greater depth below) and to the blade 46 and the staple driver 45 at the other end. The wrap protects the patient and the instrument during transanal introduction of said instrument. However, the nature of the drive mechanisms requires that the shaft be rigid. Said stiffness limits the length of axis 38, and then the combination of the length and stiffness characteristics of the instrument imposes a limit on the sections of the colon that can be  Deal with this device.

The handle 34 of this technique instrument above comprises a pistol grip type structure provided with a rotating disk 32 in the cylinder head (the opposite end to the union of the shaft part with the handle) and a trigger 44 that It is operated with a finger. The trigger comprises a mechanism of security that physically prevents the drive unless it remove from interference position. The rotating disk 32 It presents a type of coupling that can be operated with a worm that is used to advance the first rod of the shaft part (and thereby advance the rod coupling and anvil 36). The trigger works as a basic lever to push the second rod forward inside of the shaft, and thereby advancing the blade 46 and the impeller of staples 45.

As happens in many similar devices of prior art, all these devices are considered fully disposable and, in reality, are removed after being used once. These are complicated devices, which have several parts mobiles that require considerable structural integrity and, for consequently, they incur more manufacturing costs. Since I only know used once and that no part of these, the use of such devices is expensive and entails a waste of resources.

In addition to this ruling, easily deductible to from the preceding descriptions, the devices of prior art suffer from numerous other limitations that will be desirable to overcome. These include the need for the surgeon manually operate a number of different functions (including those associated with the disc and the trigger of the instrument of anastomosis and staple suture and the various triggers of linear staple and suture instrument).

Therefore, one of the objectives main of the present invention is to provide a cutting instrument, anastomosis and staple suture that can be used in gastrointestinal surgery and reduce waste of resources allowing the reuse of some parts of the same.

Another object of the present invention is to provide a set of instruments that reduce the requirements of manual operation by the surgeon of different components and mechanisms.

Other objectives of the present invention are may deduct from the description of this provided to continued and in the detailed description of the ways of preferred embodiments in conjunction with the other figures.

In US Patent No. 4,941,454, a steering mechanism servo-driven for an endoscope. In said mechanism, opposite pairs of wires are shifted to deflect the endoscope tip in perpendicular planes of motion. Be connect a servomotor to each pair of cables. The servomotors are they hold on a sliding support along a rail. He support is diverted to the frame by springs. Yes the wires tighten above a predetermined limit, the springs they will yield to allow the support to move along the lane and avoid stretching the cables.

Summary of the invention

The present invention provides a set of electromechanical car that is combined with a steering mechanism of steering cables of an instrument like the one described in the claim 1 and controlling said mechanism.

The objectives of the present invention cited previously achieved by a combination that is suitable to be mounted within an electromechanical drive assembly that is attaches to a linear staple suture accessory and an accessory anastomosis and staple suture and triggers them. One more reading insightful of this report will show that both instruments of prior art, described above, present dual actions  Similar. More particularly, the staple suture instrument linear first compresses and then staples, and the instrument of anastomosis and staple suture moves one part forward and backward of anvil, in fact performing a compression action, and then push a blade and staples forward. Therefore, it is possible to build a single common drive assembly that can be used to activate the functions of each of the instruments, so that the functions that differ are the corresponding to the accessories only and not to the entire instrument. The present invention encompasses several components of said drive assembly.

More particularly, the present invention it comprises a plurality of engines and related components that together they allow the electromechanical drive assembly check the flexible drive shafts of the drive assembly electromechanical and remotely direct the distal tip of the part of the flexible shaft of the electromechanical drive assembly. The present invention can comprise two drive motors selectively attachable that selectively rotate the drive shafts of a surgical accessory. In particular, each of the drive motors rotate selectively a drive shaft of a surgical accessory, communicating mechanically with the flexible shaft of the drive assembly electromechanical ending in a coupler at the distal tip of the flexible drive shaft of the electromechanical drive assembly,  to which the surgical accessory can be attached (in the same way that one of the surgical accessories disclosed in the present memory).

The present invention may further comprise two selectively attachable steering motors to drive steering cables that communicate with the axis of flexible drive of the electromechanical drive assembly. In in particular, the steering motors communicate mechanically with corresponding pulleys, around which they are rolled the steering cables. The selective drive of the engines of direction allows to selectively rotate the pulleys to selectively advance or reverse the steering cables. The advance or retraction of the steering cables make possible the Selective direction of the flexible drive shaft of the assembly electromechanical impeller within a spatial plane. That is, the flexible drive shaft can be moved in any direction, at the will of the surgeon.

The present invention may further comprise a pulley carriage on which the pulleys move within the handle of the electromechanical drive assembly, and a motor carriage of direction on which the steering motors move inside the handle of the electromechanical drive assembly. Since the Steering engines communicate mechanically with the pulleys of As indicated, the cars move together. The cars move on rails for cars that are arranged in the handle of the electromechanical drive assembly. Some springs adjacent to the part of the rails between the internal handle wall of the electromechanical drive assembly and the pulley carriage act on the steering cables and leave them in tensioned, moving the pulley carriage away from the inner wall. In this tensioned state, the steering wires are capable of directing the flexible drive shaft in the manner described above. The present invention further comprises a carriage motor that is mechanically communicates with the pulley carriage, to allow selectively that the pulley carriage yields to the tension of the springs or push the pulley carriage into the inner wall of the handle of the electromechanical drive assembly with a force enough to overcome the tension of the springs. That is, for allow the steering cables (and therefore the axis of flexible drive) disengage, the surgeon couples the motor of the car when you want the steering cables to remain in flexible state

As indicated above, the components of the present invention are suitable for mounting within an electromechanical drive assembly that couples with a linear staple suture accessory and an anastomosis accessory and suture by staples and that activates said accessories. It is planned the use of other accessories, too. Drive set electromechanical and the aforementioned accessories are described in greater depth later to facilitate understanding of the use of the present invention

First, with respect to the impeller electromechanical, the impeller has a handle (where they are mounted  the components of the present invention) and a drive shaft flexible. The handle features a pistol grip type design and it is provided with finger triggers that are coupled independently to the engines of the present invention, each of which performs the functions described above. The engines, which are double direction, are coupled to some manually operated top mounted switches of the handle, by means of which the user can alter Selective direction of rotation of each motor. This ability to double direction can be developed in the simplest way, selecting motors that turn in one direction corresponding to the direction of the current, and the pulsation of the drive switches will alter the direction of the current as it should. In this example, the source of motor power must be a source of current continues, such as a battery (and more preferably, a battery rechargeable) In case the electromechanical drive assembly can be used with alternating current, a transformer or intermediate gear set more improved. In conjunction with the present description, it will describe an electromechanical drive assembly in which uses a rechargeable battery that supplies power keep going.

In addition to engines and other components of the present invention, the handle further comprises other diverse characteristics, among which are an indicator remote status and at least one electrical source additional. First, the remote status indicator can comprise an LCD (or similar reading device), by means of the which user can find out the position of the components (to know, for example, if a compression element is in the correct position before the application of the clips). In second, the handle can comprise a source of energy Additional electric and an on / off switch for selectively supply electrical energy to accessories.

Also referring to the engines of address of the present invention, the handle also comprises manually operated steering means, for example a lever or a ball of command, to direct the movement of the axis flexible (using the steering cables of the present invention described above that extend into the shaft part flexible).

In the present embodiment of the assembly electromechanical impeller, the impeller components are integrated into the controller components. It must be considered than other embodiments of the drive assembly electromechanical can comprise a separate drive unit physically of the controlling unit; that is, the unit drive can understand the engines and the steering means described above, and the controller unit may comprise the triggers, the status indicator and the steering means manually operable described above. The components of the controller unit communicate with the components of the drive unit via wireless transmission, for example to through infrared and radio waves and other waves electromagnetic or ultrasound. In such configuration, by For example, the drive unit may be out of range from the surgeon's hand, while the controlling unit can selectively engage the part of the flexible shaft that is closer to the patient and closer to the surgeon. It must be taken in It also states that other additional embodiments of the electromechanical drive assembly can comprise more than two separate units, and that each of these units can contain only one, or more than one, of the separate components described above, all of which is communicated to through the wireless media described above. By example, the remote status indicator described above it can be part of a third unit that is installed in a visor that the surgeon can wear. It should be taken into account in addition to all communications between the described components herein may take place in said forms of alternative realization through wireless means.

Also, with respect to the flexible axis, the axis it comprises a tubular envelope preferably constituted by a Simple elastomeric material that is compatible with human tissue and that it can be sterilized (that is, it is robust enough as to support an autoclave). The shaft provided together with the Electromechanical drive assembly can have varying lengths. In such a case, the flexible shaft and handle parts should be detachable If they are removable, the interconnection zone between the proximal end of the shaft and the distal end of the handle should comprise coupling means for the components functional of the electromechanical drive assembly.

Making particular reference to the components shaft impellers, inside the elastomeric sheath find a pair of smaller fixed tubes each of which It contains a flexible drive shaft that is capable of rotating inside the tube The flexible drive shaft itself simply must be able to move the torque from the motors of drive to the distal end of the shaft, while maintaining flexible enough to bend, bend, bend, etc., depending on the needs of the surgeon "crawl" through the patient's colon. For example, the axes of drive can comprise a woven steel fiber cable. It should be noted that other drive axes may exist suitable for this purpose. However, for the end distal drive shaft is coupled with an accessory, such as the compression device and staple suture (described in greater depth later), the distal tips of the axes of drive must be shaped so that it is possible the continuous movement of the rotation torque. For example, the tips distal drive shafts can be hexagonal to that can fit into a hexagonal recess in the area of accessory coupling. Mechanisms can be provided suitable gear on the distal end of the shaft or on the part of the zone of interconnection of the accessory to ensure that transmit the appropriate rotation torque to the accessory. How has it indicated above, in conjunction with the management means manually operable installed on the handle, the wrapper further comprises the steering cables of the present invention that are flexible, but that are coupled to the inner surface of the envelope near the distal end of it. How has it described above, the steering cables can move axially with respect to each other by actuating the steering motors, action that causes the envelope to bend and curve properly.

Also, as indicated above, In conjunction with the LCD indicator of the handle, the axis contains also an electric cable to attach to the accessories. This cable electric channels a signal from the accessory to the handle to indicate the status of the accessory (for example, if the function of compression is active). Similarly, a second can be provided electric cable to supply power to different aspects of the accessory if necessary (for example, as will be described more in detail with respect to an embodiment of the Linear staple suture accessory, you can afford the use of a selectively attachable electromagnetic joint to ensure constant compression throughout the procedure staple suture, which requires the selective supply of energy from the handle power supply.

More particularly, with respect to the accessory of compression and suture by linear staples that presents several forms of different potential realizations (two of which are given to know herein as an example), the accessory it is provided with two command extensions, which in operation they act as extensions of the flexible drive shafts of the electromechanical drive assembly. That is, when the accessory is Coupled with the electromechanical drive assembly, the extensions of command establish a mechanical communication with the axes of flexible drive, so that the activation of the drive shaft motors cause the activation of the Stamping Compression and Staple Suture Control Extensions  linear. In each embodiment of the accessory, the first command extension enables a linear compression mechanism, while the second command extension enables a mechanism of Staple suture. In one embodiment, the mechanism of linear compression comprises a scissor and sleeve system, by middle of which the pivoting upper jaw of the scissors is pushed against the fixed lower jaw of the scissors when displaces a sleeve that covers a section of the scissors from the end of scissor hinge toward end of scissor That is going to close. The scissors can open when the sleeve returns to its original position. In this embodiment, the first command extension advances or retracts the sleeve, depending on the direction of rotation of the corresponding motor of the electromechanical impeller

In a second embodiment, the linear compression mechanism comprises a separation system of jaws, by means of which it is raised and subsequently lower the upper jaw to come into contact with the jaw bottom and perform compression. In this embodiment, the first command extension drives a pair of threaded shafts verticals that raise or lower the upper jaw, depending of the direction of rotation of the corresponding set motor electromechanical impeller

In each of these embodiments, the Staple suture mechanism comprises a staple loader open detachable arranged inside the lower jaw and a set of corresponding staple guides installed in the upper jaw, so that when the mechanism of Linear compression is in the closed position, the staples open are placed directly in front of the corresponding staple guides. The staple suture mechanism further comprises a wedge thrust system, by means of which, once the linear compression mechanism is in the closed position, it pushes along the channel a wedge that is mounted on a channel located under the open staple loader. When the wedge is displaced by the channel, an inclined surface of the wedge pushes the staples open against the corresponding staple guides, thereby closing the staples. After the closure of the staples, the wedge crawls through the channel to its original position. The second command extension pushes or draws the wedge through the channel, depending on the direction of rotation of the corresponding motor of the electromechanical impeller, driving a threaded horizontal axis on which the wedge moves, which is provided with a thread corresponding internal.

The distal ends of the closing jaws scissor or linear type may further comprise a mechanism of electromagnetic immobilization that serves to keep the distal jaw tips during the suture stage by staples This possibility is preferred to the extent that the action of moving the staples up to place them in front of the Staple guides of the upper jaw can be used to open the jaws In addition, the electromagnetic immobilization mechanism may present a coupling with the LCD indicator mechanism arranged in the handle (described above) that allows the electrical communication, so that the surgeon who uses the device will know when the jaws are closed and the device is in a staple application position safe.

Referring to the anastomosis accessory and staple suture, a form of preferred embodiment as a single example of the different variants They can be built for an equivalent purpose. However, as with the linear staple suture accessories described previously, this example demonstrates the universal applicability of the global mechanism of the electromechanical drive assembly. This accessory comprises an anvil part and a staple part, blade and tank, comprising a pair of drive shafts swivels that are attachable with the drive components of the shaft element described above, and a corresponding pair of forward and reverse nuts mounted on drive shafts rotating, which cannot rotate or, therefore, advance and go back linearly along the axes when they are spinning

The anvil part takes the form of a bullet and It has a flattened upper part, a flat support surface for cutting at the bottom and a coupling rod of free spin that extends axially from the bottom surface. This coupling rod is designed to engage and selectively disassemble from the corresponding nut mounted on one of the rotating drive shafts.

The staple, blade and deposit part (part SBR) adopts a cylindrical shape and forms a hollow shell. The Internal cavity forms the deposit. On the oriented surface axially out of the cylindrical wall of the housing, it find a series of openings for the device clips to through which these can be applied. Inside the walls cylindrical and under the openings of the staples, it is mounted a series of staple impellers that pass the staples to Through the openings. More exactly, the staple drivers they are a series of bumps located on the outer edge of a single cylindrical component that is held on the wall of the part SBR Before being applied, the clips are installed in the holes  and pass through these thanks to the advance movement of the impeller of staples and their protuberances. The blade is also cylindrical and is arranged inside the housing, against the internal surface of the wall of this. Both the blade and the staple impeller are mounted on the second nut, which at its It is also mounted on the other rotary drive shaft. When the rotary drive shaft rotates, the nut (whose rotation is restricted) advances along the axis and advances linearly in this way the blade and the staple impeller. Is It is therefore possible to advance the blade and the axial direction staple driver selectively out of the housing, of compliance with the appropriate trigger drive of the mango.

In a preferred embodiment, the part of the anvil and the SBR part further comprise a sensor mechanism electromagnetic coupled to the LCD indicator of the handle, which active when the two sides have approached each other in the necessary measure for the safe application of the staples and that allows the surgeon to know the condition of the accessory at a distance located inside the colon.

In practice, this accessory is used, a once the desired colon section has been removed (but before that ends the stage of compression and suture by linear staples), of the form indicated below. The surgeon starts by attaching the anastomosis and staple suture attachment to the impeller assembly electromechanical and extending the anvil part until it is It reaches its maximum length. Then the head of the anvil and inserted into the partially open proximal end. As described above, this proximal end is closed. then through a suture. The surgeon raises the shaft and the SBR part of the accessory through the colon until it passes through the stapled distal end of the colon. The surgeon then couples the anvil to the forward and reverse nut of the corresponding axis of drive The subsequent activation of the handle motor determines that the anvil retracts towards the SBR part. How has it indicated above, in a preferred embodiment, the Anvil base and the outer edge of the SBR housing comprise a electromagnetic sensor that is coupled to the LCD indicator of the handle and by which the surgeon can know when the anvil and the SBR part have come close enough to trigger the blade and staples. The subsequent drive of the other handle trigger determines that the other drive shaft corresponding swivel advance blade and impeller staples to come into contact with the opposite face of the anvil. The blade cuts through the closed ends with staples of the colon, leaving the tissue removed inside the internal reservoir. So Simultaneously with the cut, the newly opened ends come together through a series of staples that are applied through perimeter edge openings of the SBR part (pressed and closed on the opposite side of the anvil). Then withdraws the accessory and the flexible axis of the patient.

It will be apparent that the present invention offers a necessary component for the drive assembly electromechanical in order to overcome the limitations of the prior art In particular, the present invention increases the reuse capacity of the electromechanical drive assembly, compactly offering all the necessary components to perform the functions of the electromechanical drive assembly and the associated accessories. Therefore, the present invention helps to provide an instrument for cutting, anastomosis and suturing by staples usable in the field of gastrointestinal surgery, which reduces the waste of resources allowing the reuse of parts of said instrument. In addition, the electromechanical base of components of the present invention make the manual activation by the surgeon of the different components and mechanisms. That is, through automation and the mechanical drive functions of the present invention, the surgeon experiences less fatigue and achieves greater precision throughout the intervention.

Brief description of the drawings

Figure 1 is a side perspective view of a linear staple compression and suture instrument of prior art;

Figure 2 is a side perspective view of an anastomosis and suture instrument by technique staples previous;

Figure 2a is a perspective view. partially sectioned of a carriage assembly according to the present invention;

Figure 3 is a side view of a handle and a flexible shaft of an electromechanical drive assembly, in which certain characteristics of the present invention are represented in virtual lines;

Figure 4 is a side view of a form of realization of compression fitting and linear staple suture for use with the electromechanical drive assembly, in which the internal characteristics of the elements are represented in virtual lines;

Figure 5 is a side view of a second embodiment of the compression and suture attachment by linear clips for use with the drive assembly electromechanical, in which the internal characteristics of the elements are represented in virtual lines; Y

Figure 6 is a partially sectioned view side of an anastomosis and staple suture accessory for use with the electromechanical drive assembly.

Detailed description of the embodiments preferred

Although the present invention will be described in more detailed way referring to the attached drawings that illustrate particular embodiments, must be taken into account first of all that subject matter experts can apply modifications to the present invention described herein memory without affecting the functions and results of this invention. Consequently, the following descriptions should not be considered as limiting the scope of the present invention, but illustrative and exemplary of structures, aspects and particular characteristics of that scope. Numbers are used similar to refer to similar characteristics of similar elements.

More particularly, the present invention is refers to an electromechanical carriage assembly that is combined with a steering cable steering mechanism located in the inside a flexible shaft and that controls said mechanism, and that in the preferred embodiment it is suitable for use with a suitable electromechanical drive assembly and accessories, such as the compression and suture accessory by linear staples and the accessory of anastomosis and suture by staples disclosed in the present memory The interrelation of these components should be apparent from the previous description and the next.

Referring to Figure 2a, this The invention comprises a plurality of engines. Must be understood that one or all engines are selectively dockable by the surgeon using selection buttons or similar devices located on the outer surface of the drive system handle electromechanical, and that said motors are connected to the source or the power supplies (not shown) of the set electromechanical impeller The power supply is preferably, but not necessarily, a battery source of Removable and rechargeable direct current. It must be considered that it is possible to use alternative power supplies, including double DC sources or sources of single remote alternating current (alternating current such as the supplied by standard 120 V, 60 Hz wall outlets of the United States), in conjunction with embodiments alternatives. In case the electromechanical drive assembly can be used with alternating current, it will be possible to install a transformer between the motors of the present invention and the power supply or a gear set may be provided more perfected intermediate between the engines of the present invention and any extended rotary drive shaft.

The carriage assembly comprises two motors of selectively attachable drive 100 to rotate the drive shafts of a surgical accessory (not shown) selectively In particular, each drive motor 100 selectively rotates a drive shaft of an accessory surgical, mechanically communicating with a drive shaft 120 that is mechanically coupled with the drive shaft flexible (shown in figure 3) of the drive assembly electromechanical, which ends in a coupler (represented in the Figure 3) located at the distal tip of the drive shaft flexible electromechanical drive assembly, to which you can attach a surgical accessory (such as one of the accessories surgical methods disclosed herein).

The carriage assembly further comprises two selectively attachable steering motors 130 to drive steering cables 140 that communicate with a flexible shaft of an electromechanical drive assembly (shown in Figure 3). In particular, the steering engines 130 communicate mechanically by means of steering shafts 150, connected to through rotating torque transmitting joints (not visible) with corresponding pulleys 160 around which winding the steering wires 140 as shown. He selective drive of the steering motors 130 allows perform the selective rotation of the drive shafts 150 which selectively rotate pulleys 160 to advance or selectively retract the steering cables 140. For example, when the pulley 160 shown in the direction of steering motor 130, the top 170 of the steering cable 140 is dragged towards the steering motor 130 and the part bottom 180 of the steering cable 140 is dragged in the direction contrary to the steering motor 130. This drive allows the Selective direction of the flexible shaft of the drive assembly electromechanical within a spatial plane. That is, for example, the traction of the top 170 described displaces upwards the flexible shaft of the electromechanical drive assembly while the traction of the bottom 180 described displaces down The flexible shaft. In this example, it should be noted that when the other pulley 160 is rotated, the flexible shaft is dragged left or right, as needed of the surgeon

The carriage assembly further comprises a carriage of pulleys 190 on which pulleys 160 move within the handle of the electromechanical drive assembly, and a motor car of steering 200 on which the steering engines are move 130 inside the drive assembly handle electromechanical. That is, since the steering engines 130 are mechanically communicate with pulleys 160 as indicated, cars 190, 200 move together. The 190 cars, 200 move on rails for cars 210 that are mounted on the handle of the electromechanical drive assembly. Some springs 220 adjacent to rails 210 shown have the steering cables 140 and leave them in a tensioned state, moving away the pulley carriage 190 of the internal wall of the assembly handle electromechanical impeller In this tensioned state, the cables of address 140 are able to steer the flexible shaft of the assembly electromechanical impeller in the manner described above. He carriage assembly further comprises a carriage 240 which is mechanically communicates with pulley carriage 190 to allow selectively that the pulley carriage 190 yields to the tension of the springs 220 or push the pulley carriage 190 towards the wall internal handle of the electromechanical drive assembly with a sufficient force to overcome the tension of the springs 220. It is say, to allow the steering wires 140 (and by consequently the flexible axis) distends, the surgeon activates the carriage 240 when you want the steering wires 140 remain in a flexible state.

The carriage assembly described above is preferably fixed inside a drive assembly electromechanical. Referring to figure 3 and with respect to the electromechanical drive assembly 100, the drive assembly electromechanical features a handle part 102 and a shaft part flexible drive 104. The handle 102 comprises a part which It adopts a form that facilitates the grip by the surgeon. By example, in the embodiment described herein memory, the handle comprises a pistol grip type part 106. The grip portion 106 comprises at least two, and in the embodiment described exactly two, finger triggers independently operable 108a, 108b. The triggers of finger 108a, 108b are independently coupled to the motors of drive of the present invention (see elements 100 of Figure 2a described above), represented as elements 110, 112, located within the internal volume of the handle 100. Such as described and as represented herein, each drive motor 110, 112 (elements 100 of the figure 2a) spins a separate flexible drive shaft (described in more detail later).

Although not shown in Figure 3, the other components of the carriage assembly of the present invention they are also installed inside the handle part of the electromechanical drive assembly, including motors steering and car engine. The drive motors and these Additional engines are double direction motors, and all of them are coupled to finger operated switches similar to triggers operable with a finger 108a, 108b represented in Figure 3. Each motor is also coupled separately to the source of energy 114 (which is a common source in the embodiment represented) and to manual switches similar to manual control switch 116 shown in figure 3. The manual control switch 116 is located at the top of handle 100, thereby allowing the surgeon to alter selectively the direction of rotation of each drive motor. The surgeon can similarly use manual switches additional to selectively alter the direction of rotation of The other engines. In the embodiment shown, the 114 engine power supply is a single battery Removable and rechargeable that supplies direct current. Should keep in mind that it is possible to use power supplies alternatives, including double dc sources or single remote AC sources (alternating current such as that supplied by the 120 V, 60 wall outlets United States standard Hz), in conjunction with forms of alternative realization. In case the drive assembly electromechanical can be used with alternating current, can add a transformer between the motors and the source of feeding or an intermediate gear assembly can be provided  more perfected between the motors and the drive shaft extended rotary.

Also, referring to Figure 3, in addition to the engines and other components of the carriage assembly and the power elements and switches, the handle 100 comprises a remote status indicator 118 and a circuit associated electrical 120. Indicator means of this form of embodiment comprise an LCD installed on the top of the mango. It should be noted that it is possible to obtain a function equivalent by installing an audible alarm or other mechanism of conventional sensory stimulation in the handle. The indicator of remote state 118 is coupled to an electrical circuit associated that extends along the handle and flexible shaft and it is coupled with a corresponding electrical circuit of the accessory Surgical selected (see Figures 4 to 6). The disposition of the surgical accessory, in a closed or open position by example, it is associated with the state of open circuit or closed circuit of the circuit of the surgical accessory. In the circuit state closed, the LCD of the remote status indicator turns on, while in the open circuit state the LCD turns off.

In particular, referring also to the steering motors, pulleys, steering cables and associated components of the present invention, the handle comprises also manually operated steering means, which in the present embodiment comprise a control ball 124, which drive motors of the present invention such as described above, which in turn actuate the cables of address 126 (elements 140 of Figure 2a). Wires direction extend along the flexible shaft part 122 (described in greater detail below) and attach to the tip of the flexible shaft 122. When the control ball 124 is rotated, the steering motors of the present invention pull the cables of steering 126, and the tip of flexible shaft 122 rotates in consonance with said traction.

More particularly, with respect to the axis flexible 122, the shaft comprises a tubular casing 128 that is consisting of a simple elastomeric material compatible with the human tissue. Since such a device must be reused, it is important that the material be sterilizable (i.e. robust enough to support an autoclave). Although the represented embodiment comprises a handle 100 and a shaft 122 contiguous, it should be borne in mind that people with basic knowledge of the subject may design a form of alternative embodiment with a detachable handle and shaft, which will therefore facilitate axes of alternative lengths for alternative purposes In such cases, the shaft parts flexible 122 and the handle 100 should comprise an area of coupling between the proximal end of the shaft and the distal end of the handle which must comprise coupling means for the electromechanical components

Making particular reference to the components impellers 130a, 130b of axis 122, inside the housing elastomeric 128 is a pair of smaller fixed tubes 134a, 134b, each of which contains a drive shaft flexible 136a, 136b that is able to rotate within the corresponding tube 134a, 134b. Each flexible drive shaft 136a, 136b must being able to move a rotation torque from the drive motors of drive shaft handle electromechanical to distal end 138a, 138b of axis 122, and remain flexible enough to bend, bend, bend, etc., according to the needs of the "crawling" surgeon through the patient's colon. For example, flexible drive shafts can comprise a cable woven steel fiber, a high strength polymeric material to traction or a single metal shaft flexible enough.

So that the distal ends 138a, 138b of the flexible drive shafts 136a, 136b are coupled with a accessory, such as compression attachment and staple suture linear (see Figures 4 and 5), distal tips 138a, 138b of flexible drive shafts 136a, 136b must be shaped in such a way that they can continuously transmit the rotation torque In the embodiment shown, this Coupling is done using a geometric adapter. Said with more accuracy, the distal tips of the drive shafts flexible are hexagonal and therefore fit inside recesses hexagonal coupling area of the accessory. In certain embodiments of the electromechanical drive assembly, the accessory and the distal end of the flexible drive shaft they must comprise a ring, or other type of alignment means, to facilitate the adjustment of the accessory at the distal end of the shaft Flexible drive. In addition, the tip of the shaft flexible drive can comprise the distal ends of the circuit 120 that is coupled to LCD 118, as well as others coupling components necessary to transfer functions from the electromechanical drive assembly to the accessories.

Referring to figures 4 and 5, Represent two staple compression and suture accessories Alternative linear The first linear compression mechanism, depicted in figure 4, comprises a separation system of jaws comprising a lower jaw 150 and a jaw upper 152 and a proximal interconnect end element 154. This proximal end member 154 comprises two bushings hexagonal shape 156a, 156b within which the distal tips 138a, 138b of the drive shafts of the coupled electromechanical drive assembly. Each of the bushings is located at the end of a corresponding shaft horizontal swivel 158a, 158b. Horizontal rotating shaft upper 158a is coupled, by means of a gear element transverse, to a threaded vertical axis 160 extending through of a corresponding threaded bore 162 located in the jaw upper 152. The upper jaw 152 has a means of linear groove coupling 166 that correspond and fit with a linear groove 168 formed on the side of the element of interconnection end 154 in front of the bushings  drive system coupling 156a, 156b. A subsequent rotation of the upper horizontal rotating shaft 158a causes the rotation of the vertical rotary axis 160. When this axis 160 rotates, the jaw upper 152 rises and falls within the groove of the element of end 154.

The lower horizontal rotating shaft 158b is extends axially along the lower jaw 150, which at its Once attached to proximal end element 154. Installed around this axially extending axis 158b is a wedge drive mechanism 166 comprising a perforation threaded This threaded element 166 is locked within a slot 167, which prevents rotation of element 166 when the shaft 158b is spinning. Instead, wedge element 166 moves linearly along slot 167 and along the thread of shaft 158b. Arranged inside a recess 168 located on the face of the lower jaw 150 which is located opposite the jaw upper 152, directly above wedge element 166, is Find a replaceable staple loader. Wedge impeller it has an inclined front surface 172 that comes into contact with staple 174 and push it up by pulling it out of the tray 170. When the upper jaw 152 is near the lower jaw 150, the staples close when they enter contact with the opposite face of the upper jaw 152 (per action of the staple closure guide recesses 176 formed in is).

On the distal tip of the upper jaws and lower, there are two opposite magnetic sensors 178a, 178b, each of which is coupled with a circuit component which is coupled with the distal ends 120 of the circuit of the LCD indicator 118. When the jaws come together, the circuit will closes and the LCD indicator lights, indicating that the staples They can be applied safely.

In operation, the surgeon cuts the tube from the colon on both sides of the cancerous tissue, thereby creating two bowel ends The surgeon uses the accessory compression and suture by linear staples to temporarily staple The open ends. More particularly, the accessory of compression and linear staple suture is coupled with the end distal of the electromechanical drive assembly. By manually activating  a trigger (the one that causes the rotation of the upper shaft 136a), the upper jaw 152 opens in relation to the lower jaw 150. The open end of the colon is then placed between the jaws 150, 152, and the jaws close by changing the direction upper shaft drive 136a and pushing the upper jaw in the opposite direction. The jaws close in this way on the end of the colon At that time, the LCD indicator 118 of the handle should light up, to indicate that the staples can apply safely.

Second axis rotation activation 136b causes the wedge impeller 166 to slide along slot 167 of the lower jaw 150. This makes the staples 174 cross the colon and close against the guide recesses of closure of staples 176. Then, the jaws and wedge impeller 166 retracts inside the jaw lower 150, then the staple magazine 170 is replenished 174 and Repeat the process at the other open end of the colon.

Referring to figure 5, it is described the second embodiment 180 of the compression fitting and linear staple suture. In the present embodiment, the coupling area 154 is largely equivalent to the first embodiment, since the hexagonal ends of the part of the shaft are inserted into the corresponding ends of socket 156a, 156b of the accessory. As in the previous case, the axes of the electromechanical drive assembly rotate the elements accessory swivel. However, in this form of embodiment, both rotating elements 158a, 158b are horizontal. A lower fixed jaw 150 and a upper mobile jaw 152 They are mounted on the shaft interconnection element. In this embodiment, the upper jaw 152 is mounted on the lower jaw 150 by means of a spring pivot, which press the upper jaw by placing it in an open arrangement in relation to the lower jaw. However, mounted on the shaft upper swivel, there is a linear traction sleeve 187 arranged around the upper jaw and the lower jaw, the advance of which makes the two jaws come together. Gag bottom comprises exactly the same staple loader recess 174 and staple drive wedge mechanism with linear groove 166. The sensor and the electromagnetic circuit of the first embodiment to indicate to the surgeon when the colon section is fully compressed and when they can Apply the staples.

More particularly, once the surgeon has the affected part of the colon removed, the end of the colon is place between the jaws of the accessory. Actuating the first trigger (and upper shaft), sleeve element 187 advances axially along the outside of the upper jaws and lower 150, 152, thereby closing the upper jaw over the colon and the lower jaw. Once the closure is complete, the electromagnetic sensor circuit indicates to the surgeon that it is already staples can be applied, and consequently the actuation of the second trigger causes the wedge impeller to advance and drive the  staples through the colon section. Rotation inversion of the upper rotary axis motor determines the retraction of the sleeve and opening of the upper jaw, freeing from that mode the colon end that will already be sealed.

Referring to figure 6, it is described a preferred embodiment of the anastomosis accessory and 200 staple suture. This accessory comprises an anvil part 202 and a portion of staples, blade and reservoir (SBR) 204, which It comprises a pair of rotating drive shafts 206a, 206b which they are attachable to the drive components 136a, 136b of the assembly electromechanical impeller described above with reference to the Figure 3, and a corresponding pair of feed elements and 208a, 208b recoil mounted inside grooves and on the shafts of rotary drives, which in this way cannot rotate or, consequently, move forward and backward linearly along the axes 206a, 206b when they rotate. More particularly, the basis of the part SBR 204 comprises a coupling zone 203 that it comprises a pair of hexagonal recesses 205a, 205b formed in the bases of threaded rotating shafts 206a, 206b.

Anvil part 202 is shaped like a bullet, and it has a flattened upper part 210, a support surface flat for cutting 212 at the bottom and a shank of coupling 214 extending axially from the surface lower. The coupling rod 214 is mounted on the first Forward and reverse element 208a which is mounted within a linear groove, by means of which axis rotation 206a determines that element 208a and anvil 202 coupled thereto is move axially and not rotationally.

The staple, blade and deposit part (SBR) 204 adopts a cylindrical shape, and forms a housing with a part internal hollow 216. The internal hollow part forms the reservoir. In the axially oriented surface 218 out of the wall cylindrical 220 of the housing, there are a number of openings for the staples, through which staples 224 of the device. Inside the housing, a single blade component and cylindrical staple driver 226. More particularly, the staple driver and blade component It comprises a single element that has two cylindrical parts concentric The blade part 228 is located within the hollow inner part 216 resting against the inner part of it 230. The wedge impeller portion 232 is disposed within the wall 230 of the SBR part and comprises a series of protuberances protruding outward and pushing the staples placed inside of the openings of the staples.

The blade parts 228 and impeller of staples 232 are coupled by the inner end of these to a threaded element 208b that is arranged around the rotating shaft 206b. Threaded element 208b is circumscribed within a linear groove such that the blade and staple driver they advance linearly with the rotation of the rotating shaft 206b.

In addition, the anvil parts 202 and SBR 204 each one comprises corresponding circuit components of the electromagnetic sensor 240a, 240b that are attached to the indicator LCD 118 handle.

In practice, this accessory is used after the removal of the colon section to be removed and the closure thereof by means of staple suture, in the manner indicated to continuation. The surgeon starts by attaching the accessory of anastomosis and suture by staples 200 with the impeller assembly electromechanical and advancing the anvil part 202 to which acquires its maximum extension. Then the head of anvil 202 is disengaged from the first forward and reverse element 208 and inserted into the open proximal end. How has it described above, then the end is partially opened proximal stapling of the intestine and the anvil head is inserted within this. Then the intestine is closed by suture. Next, the surgeon raises the shaft 206a and the SBR 204 part of the accessory through the colon until it passes through of the stapled distal end of the colon. (Alternatively, the surgeon you can raise only the flexible axis through the colon and then reconnect the SBR part to the distal end once it appears through the distal end of the intestine.) Next, the surgeon attaches anvil 202 to forward and reverse element 208a by rotation of the corresponding drive shaft 136a. The subsequent inversion of the rotation and drive thereof handle motor 100 causes retraction of anvil 202 towards the SBR part 204. Once the electromagnetic sensors 240a, 240b mounted on the bottom surface of the anvil 202 and the edge External housing SBR occupy positions sufficiently adjacent to close the LCD indicator 120 circuit, the LCD of the handle lights up. This indicates to the surgeon that he must activate the rotation of the second axes 136b and 206b, and advances the impeller of the staples, the blade and the staples simultaneously. The blade cuts through the closed ends with staples of the colon, and The excised tissue is stored in the internal reservoir. Simultaneously with the cut, the newly opened ends meet through a series of staples that are applied through some holes formed in the perimeter edge of the SBR part (which push and close against the opposite face of the anvil). Finally the accessory and flexible shaft are removed from the patient.

Although some systems have been described and illustrated of carriage for use with surgical instruments such as attachable electromechanical drive assembly with accessories Surgical such as compression fitting and suture by linear staples and anastomosis and staple suture accessory, it will be clear to experts in the field that it is possible carry out variants and modifications without departing, therefore, of the present invention that is limited only by the scope of the appended claims.

Claims (13)

1. Electromechanical carriage assembly in combination with a steering mechanism of steering cables a surgical instrument and to control it, which understands:

to)

a steering cable (140);

b)

by at least one steering motor (130) that the surgeon can attach selectively to couple the steering cable (140);

C)

at least spring means (220) adapted to prestress said steering cable (140) and leave it in a tensioned state, and characterized in that

d)

by at least one selectively attachable carriage engine (240) independent of said at least one steering engine, operable to overcome the tension created by said means of spring (220) and leave the steering cable (140) in condition flexible.

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2. Combination according to claim 1, in the that said steering motor (130) communicates mechanically with a pulley (160), around which said cable is wound direction (140), to selectively rotate said pulley (160) and selectively advance or reverse said steering cable (140). 3. Combination according to claim 1, in the that said at least one steering motor (130) comprises a plurality of steering engines (130), each of which used to attach a separate steering cable (140), translating said activation into the ability to address selective of a flexible axis within a spatial plane. 4. Combination according to claim 3, in the that at least said a steering motor (130) comprises two steering engines (130),

to)

he first of which serves to attach a first cable of address (140), translating said activation into the ability to selective direction of the flexible axis within a foreground space, and

b)

he second of which serves to activate a second cable of address (140), translating said coupling into the capacity of selective direction of the flexible axis in the background spatial that is perpendicular to said foreground space.

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5. Combination according to claim 4, in the that

to)

saying first steering motor (130) communicates mechanically with a first pulley (160), around which said first winding is wound steering cable (140), to selectively rotate said pulley (160) and selectively advance or reverse said first steering cable (140) and

b)

saying second steering motor (130) communicates mechanically with a second pulley (160), around which said second is wound steering cable (140), to selectively rotate said pulley (160) and selectively advance or reverse said second steering cable (140).

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6. Combination according to claim 1, in the that

to)

saying electromechanical assembly further comprises a housing of the assembly which presents an inner wall,

b)

saying steering engine (130) travels on a carriage of address (200) within said assembly housing, and

C)

said spring means (220) prestress said steering motor carriage (200) away from said inner wall.

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7. Combination according to claim 1, in the that

to)

saying electromechanical assembly further comprises a housing of the assembly which presents an inner wall,

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b)

saying steering cable (140) is wound around a pulley (160) that it travels on a pulley carriage (190) inside said housing of the set, and

C)

said spring means (220) pretend said pulley carriage (190) away from said wall internal

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8. Combination according to claim 7, in the that

to)

saying steering engine (130) travels on a carriage of address (200) within said assembly housing,

b)

saying steering motor (130) communicates mechanically with a pulley (160), around which said steering cable is wound (140),

C)

bliss Pulley (160) travels on a pulley carriage (190) within said housing of the assembly, and

d)

said spring means (220) pretend said pulley carriage (190) away from said wall internal

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9. Combination according to claim 8, in the that at least said steering motor car (200) or said Pulley carriage (190) travel on a carriage rail (210) inside said assembly housing. 10. Combination according to claim 6 or 8, wherein said carriage motor (240) communicates mechanically with said steering motor car (200) to selectively allow that said steering motor car (200) yields to the voltage of said spring means (220) or thrust said carriage of the motor of direction (200) towards said inner wall with sufficient force to overcome the tension of said spring means (220). 11. Combination according to claim 7 or 8, wherein said carriage motor (240) communicates mechanically with said pulley carriage (190) to selectively allow said pulley carriage (190) yield to the tension of said spring means (220) or push said pulley carriage (190) towards said inner wall with enough force to overcome the tension of these means spring (220). 12. Combination according to claim 5, in the that

to)

saying electromechanical assembly further comprises a housing of the assembly which presents an inner wall,

b)

saying first steering engine (130) and said second steering engine (130) move on a steering motor car (200) within said assembly housing,

C)

bliss first pulley (160) and said second pulley (160) move over a pulley carriage (190) within said housing of the set,

d)

said spring means (220) pretend said pulley carriage (190) away from said wall internal, and

and)

saying carriage motor (240) communicates mechanically with said carriage of pulley (190) to selectively allow said pulley carriage (190) yield to the tension of said spring means (220) or thrust said pulley carriage (190) towards said inner wall with a force enough to overcome the tension of said spring means (220).

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13. Combination according to any of the claims 1, 5, 11 or 12, further comprising at least a selectively attachable drive motor (100) or that attaches a fixed drive shaft.